Anne Suskind, MD, MS, FACS took third place in the American Urology Association’s Early Investigator Forum this month. Her work was titled, “Functional outcomes after “minor” urologic surgery among nursing home residents; a national study.”
Dr. Suskind’s research on treatment outcomes in frail older adults with urologic conditions leverages large national databases, such as Medicare claims data, to understand the impact of various urologic treatments (both medical and surgical) on a national level. She is particularly interested in understanding the unintended consequences associated with what are considered to be relatively “minor” urologic procedures in this population.
Abstract
Functional outcomes after “minor” urologic surgery among nursing home residents; a national study
Introduction and Objectives: Surgery is commonly performed in frail older individuals seeking care for urologic conditions. While it is known that “major” urologic surgery is associated with increased morbidity and mortality, outcomes of “minor” urologic surgery among frail older adults remain unknown. The objective of this study is to explore the long-term functional outcomes associated with “minor” urologic surgery among nursing home residents.
Methods: Using inpatient Medicare claims and the Minimum Data Set (MDS) for Nursing Homes, we identified all nursing home residents who underwent the following “minor” urologic procedures between 2004 and 2012: cystoscopy, cystoscopy with bladder biopsy, transurethral resection of bladder tumor (TURBT), prostate biopsy, transurethral resection of the prostate (TURP), removal of ureteral obstruction, and suprapubic tube placement. We examined changes in activities of daily living (ADL) and mortality up to 12 months after surgery and examined factors associated with ADL decline and mortality over this time period.
Results: We identified 37,671 individuals residing in nursing homes who underwent “minor” urologic surgery during the study period. Mean age was 81.5 (±7.4) years, 63.7% were male and 78.2% of procedures were elective. At baseline, 29.2% experienced declines in ADLs in the past 6 months and 60.3% had cognitive impairment. Following surgery, 11.5% and 48.7% of individuals were dead within 1 and 12 months, respectively, while ADLs declined steadily over this time period (Figure). Poorer baseline ADL status and ADL decline at baseline were both predictors for death or ADL decline in the 12 months following surgery [adjusted HR 1.40 (95% CI 1.28-1.53) for worst quartile of ADL status compared to best quartile] and [adjusted HR 1.38 (95% CI 1.29-1.47)], respectively.
Conclusions: Patients undergoing relatively minor urologic surgery experience detriments in function and high rates of mortality in the year following surgery. This information is important to weigh the risks and benefits of any type of surgery, no matter how small, in this vulnerable population.
Funding: NIA R03AG050872-01; NIDDK K12DK83021-07